- Adult Eye Examination
- Specialist Diagnostics & Services
- Contact Lenses
- Paediatric Optometry
- Dry Eye & Punctum Plugs
- Low Vision & Home Visits
- Sports Vision
- Diabetes
- Cataract
- Macular Degeneration
- Visual Stress Treatment
- The Glaucomas
- Diet & Ocular Health
- Colorimetry
- Cirrus HD- OCT
Adult Eye Examination
History & Symptoms
Your optometrist will:
• invite you to describe any symptoms or visual difficulties you might be experiencing
• ask about your general health and whether you are taking any medications. It is helpful if you bring with you a written list of medications as some medications can cause ocular side effects.
• ask about your past eye health and optical correction history.
• ask about family eye history, particularly with regard to macular degeneration, cataract and glaucoma
• discuss with you your visual requirements and their optical implications. For example, your optometrist will be interested to know if you use a computer, drive, have specific hobbies or play sports. There are optical as well as eye safety issues associated with most visual activities, particularly some sports such as squash, tennis, golf, cycling, and sailing.
The health of your eyes and visual system
A comprehensive series of examinations are carried out to investigate the health of the external and internal eye as well as your visual system as a whole.
Examinations will be carried out on your
• eye movements and eye muscle balance. These tests are fundamental to understanding how your two eyes work and move together.
• visual fields using either a screening strategy or a full threshold Humphrey SITA test the gold-standard test used to investigate the integrity of the visual pathway from the eye to the cortex at the back of the brain. This is a fundamental and routine test used to detect a wide range of eye and neurological disease.
• Pupil reflexes. An important routine neurological test.
• Anterior chamber angles are screened to assess risk of a future acute glaucoma. If the angles appear narrow your optometrist will assess further using a gonioscope - a special contact lens with mirrors to view into the angle - or using the Zeiss HD-OCT anterior segment technology which gives a 2-D cross sectional scan of the angle
• Eye pressures. Intraocular pressures are measured using either the screening, “air-puff” tonometer or, if we need a more accurate measurement, the Pascal DCT tonometer, a precision instrument, from Switzerland which automatically compensates for the thickness of the cornea. Whilst measuring the eye pressure is an important test it must not be considered a test for glaucoma because up to 50% of patients with glaucoma have “normal” eye pressures.
• Corneal thickness may be measured with the Zeiss Cirrus HD-OCT as an important part of glaucoma screening
• Examination of the external eyes by biomicroscopy to examine the integrity of the eye lids, cornea and conjunctiva.
• Internal eye examination is carried out using binocular indirect slit lamp biomicroscopy to check the crystalline lens, the vitreous gel and retina. This examination is designed to assess and diagnose conditions such as cataract, posterior vitreous detachment and a wide range of retinal or optic nerve conditions including primary open angle glaucoma (POAG), retinal tears/detachments, optic nerve anomalies and macular disease such as macular holes and degeneration. Sometimes we will need to dilate your pupils using an eye drop to obtain an improved view. For all of these last conditions, diagnosis is carried out with the support of the results of other tests including visual fields, eye pressures and optical coherence tomography (OCT).
The comprehensive eye examination includes a photograph of the retina and choroid (layer under the retina) of all patients using the latest technology Optos Panoramic P200C laser scanning camera which assesses up to 85% of the retina without the need to use eye drops. This is carried out routinely at each eye examination for documentation and monitoring purposes.
• An additional, non-routine investigation which is sometimes advised is Optical Coherence Tomography (OCT) using the Zeiss HD-OCT. Barnard Levit was the first optometry practice in Europe to use OCT technology which allows for a “non-invasive biopsy” of the macula, optic nerve or retinal nerve fibre layer. With a resolution of just 5 microns this cross-sectional analysis through the retina, rather than just the view of the surface, gives a highly detailed analysis of retinal and optic nerve tissue aiding early diagnosis of macular degeneration and glaucoma as well as providing accurate monitoring of these and other related conditions.
Standard of Vision and Refraction
At Barnard Levit we not only perform a detailed and in-depth refraction but our patients also have the benefit of the Zeiss i-Profiler Aberrometer and corneal topographer. This not only objectively measures your prescription for low order aberrations (short-sight; long-sight; astigmatism) but also measures high order (more complex) aberrations (trefoil; coma; secondary astigmatism; spherical aberration). Knowledge of all the aberrations of eye enables your optometrist to optimize your spectacle prescription to give enhanced vision using standard and advanced technology such as Zeiss i-Scription lenses.
Binocular vision
Your optometrist will assess your eye movements and binocular vision to ensure the two eyes are working together as well as possible. If there are any weaknesses or imbalance we can often treat them with eye orthoptics (evidence based eye exercises) and /or specific prescription glasses incorporating optical/prismatic elements to perfectly integrate binocular vision.
Review of the findings and advice
At the end of the examination, your optometrists will discuss the results with you, offer advice on optimizing your vision if required with spectacles or contact lenses, explain any relevant eye health matters and answer any questions you may have.
Spectacles
Once your optometrist has obtained a precise and balanced spectacle prescription, it is important that this is translated into spectacles that are precisely made and dispensed. For optimum vision, aberration free lenses such as Zeiss Individual™ are often advised in single vision or multifocal forms. Our Dispensing Opticians will measure the distance between your visual axes and eye position relative to the eyewear chosen, to the nearest 1/10th mm, using Zeiss RVT technology so that your spectacles can be made with the highest precision to ensure optimum visual comfort. Spectacle frames of all types and a range of qualities are available from economy styles to bespoke hand-made frames from materials ranging from high quality plastics and stainless steel to alpha titanium, gold, hardwoods or buffalo horn.